Provider Demographics
NPI:1205291440
Name:PECK, TUCKER (PHD)
Entity type:Individual
Prefix:DR
First Name:TUCKER
Middle Name:
Last Name:PECK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 SAN JOSE AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4994
Mailing Address - Country:US
Mailing Address - Phone:520-485-9411
Mailing Address - Fax:844-227-8699
Practice Address - Street 1:2103 SAN JOSE AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4994
Practice Address - Country:US
Practice Address - Phone:520-485-9411
Practice Address - Fax:844-227-8699
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4688103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical